Deptartment of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Deptartment of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Surg Obes Relat Dis. 2020 May;16(5):620-625. doi: 10.1016/j.soard.2020.01.005. Epub 2020 Jan 20.
Laparoscopic Roux-en-Y (LRYGB) gastric bypass is an effective treatment for morbid obesity. Acid-related complications after LRYGB could be prevented by prophylactic proton pump inhibition (PPI).
To identify the effect of PPI prophylaxis on short-term, acid-related complications in a large cohort.
National Registry, Sweden.
A total of 37,301 patients who underwent LRYGB in Sweden from 2009 to 2014 were identified in the Scandinavian Obesity Surgery Registry. Patient-specific factors were cross matched with socioeconomic variables and information on PPI dispensation. A logistic regression model was used to analyze acid-related complications (e.g., marginal ulcer, stricture, and perforation) within 30 days and at 1 year postoperatively.
PPI prophylaxis did not reduce the rate of acid-related complications. Instead, prolonged operation time (odds ratio [OR] 2.19 [1.53-3.13]) and immigrant background (OR 1.72 [1.17-2.53]) increased the risk of marginal ulcer within 30 days. At 1 year, medical treatment for diabetes (OR 1.75 [1.14-2.67]) and dyspepsia (OR 1.71 [1.06-2.75]), larger gastric pouch (OR 2.19 [1.528-3.248]), longer operation time (OR 1.67 [1.11-2.51]), smoking (OR 2.59 [1.77-3.78]), and immigrant background (OR 1.60 [1.08-2.36]) increased the risk for marginal ulcer, while older age (OR 2.20 [1.05-4.63]) predisposed for stricture. Inferior weight loss was associated with marginal ulcer at 1 year (OR 1.50 [1.04-2.15]).
PPI prophylaxis did not reduce the risk for marginal ulcer and stricture. The risk for these complications was increased by several co-morbidities, smoking, immigrant background, and surgical factors. Routine use of PPI prophylaxis cannot be recommended, but smoking cessation and optimal surgery could be important.
腹腔镜 Roux-en-Y（LRYGB）胃旁路术是治疗病态肥胖症的有效方法。预防性使用质子泵抑制剂（PPI）可以预防 LRYGB 后的酸相关并发症。
在一个大样本中确定 PPI 预防对短期酸相关并发症的影响。
瑞典国家登记处。
在斯堪的纳维亚肥胖手术登记处，确定了 2009 年至 2014 年期间在瑞典接受 LRYGB 的 37301 名患者。将患者的具体因素与社会经济变量和 PPI 分配信息进行交叉匹配。使用逻辑回归模型分析术后 30 天和 1 年内的酸相关并发症（如边缘性溃疡、狭窄和穿孔）。
PPI 预防并不能降低酸相关并发症的发生率。相反，手术时间延长（比值比 [OR] 2.19 [1.53-3.13]）和移民背景（OR 1.72 [1.17-2.53]）增加了术后 30 天内边缘性溃疡的风险。1 年后，糖尿病（OR 1.75 [1.14-2.67]）和消化不良（OR 1.71 [1.06-2.75]）的药物治疗、较大的胃囊（OR 2.19 [1.528-3.248]）、手术时间延长（OR 1.67 [1.11-2.51]）、吸烟（OR 2.59 [1.77-3.78]）和移民背景（OR 1.60 [1.08-2.36]）增加了边缘性溃疡的风险，而年龄较大（OR 2.20 [1.05-4.63]）则增加了狭窄的风险。1 年后体重减轻不理想与边缘性溃疡有关（OR 1.50 [1.04-2.15]）。
PPI 预防并不能降低边缘性溃疡和狭窄的风险。这些并发症的风险增加与多种合并症、吸烟、移民背景和手术因素有关。不能推荐常规使用 PPI 预防，但戒烟和优化手术可能很重要。
